Optic nerve atrophy

[eflc]

Hi, I'm looking for anybody who has any idea of what could be causing severe eye disorder of my mother. I'll try to describe all information available so far.

She is now 44 and about a year ago she first felt that her eyesight dropped a bit in one eye. In addition she started to see something like thin black circles with a dot in the middle that would float in front of her eye. Later the number of circles has increased. The eye became way more irritated towards bright light (sunny days) and bright light would usually make the seen circles more often and pronounced. About two months later she got the same thing in her other eye, also seing some circles like in the first one.

We have since visited quite a lot of clinics, with various conclusions. Initially she was diagnosed with strong optic nerve inflammation and odd changes to it, which no doctor so far has been able to recognise. Now, just a week one of the doctors who saw her about a year ago said that the changes in the optic nerve became way more pronounced it became whiter and diagnosed optic nerve atrophy. She just completed the field of vision test (where bright dots appear and she said if she sees them) and conductivity of the optic nerve (she was shown alternative and flickering black and white squares with electrodes attached to her head) here in a dutch optic clinic and the doctor said both test results are fine. She had several MRI scans done on the brain and spine, and nothing has been found. She had tests for Multiple Sclerosis, apart from lumbar puncture done, which were all negative. She was several times tested for diabetes negatively. She does not take any drugs, nor smoke or drink.

She has been diagnosed about 2 months ago with Toxoplasmosis and has been taken antibiotics since. Her results went from 5x above norm to 3x above the norm so far, yet the eyesight situation has been decreasing without any change.

Another interesting observation is that when she was getting gentamicin injection to treat her kidney problems, she reported an improvement in her eyes to. Interestingly enough, the kidney problems she had for the last 20 years and made her get gentamicin injections multiple times a year, have disappeared now since she started taking antibiotics regularly to treat Toxoplasmosis.

She has also been complaining about strong headaches. During several of the brain stimulation test with electrodes not only she reported that she can feel it, she actually got involuntary convulsions, kind of like epileptic yet she always remained concious. The doctors first said this was impossible and noone can feel the test yet after it happened right in their presense they could not offer any explanation of what it is or what might be causing this.

All of the doctors so far see very severe optic nerve disorder yet none has any idea what could be causing it. I would be very grateful if anybody could hint in any direction of what might be causing it, what tests could be done.

If there is any further information that you need to complete the picture that I might have missed, please just ask.

Thank you for reading and I really hope you can help.

[John C Hagan III, MD, FACS, FAAO]

1.  I really can't advise you on LP.  
2. Treatment is usually a do nothing b. IV steroids for 3 days followed by oral steroids for 7 more days.
3. Optic neuritis damages the pupil reflex nerve fibers also so they behave erattically.

JCH MD

[eflc]

Dear Dr. Hagan,

Thank you for your comment.

It does sound like Multiple Sclerosis could still be an underlying cause, so do you think she should get the lumbar puncture done, which, from what I read can diagnose MS with about 90% correctness and also can reveal some other issues?

Also, is there anything that could be done now to decrease the damage from the inflamation, and to either improve or stabilize her eyesight?

Right now her eyesight is extremely unstable one day being under 20/200 the other reaching 20/50. Another odd thing happened just recently. A couple of days ago her pupils were extremely contracted, i'd say about 2mm in diameter. They remained so all day but she did not take any new medication before or since. Today we noticed the exact opposite - her pupils are larger than normal about 8mm in diameter. The even odder thing is that they are completely insensitive to brightness variations - absolutely no change between looking at a bright source of light and in a dimmed room. What could be causing this?

[John C Hagan III, MD, FACS, FAAO]

Your description of mothers problem is consistent with optic neuritis or neuroretinitis that damaged the optic nerve severely and over time the nerve developed atrophy. It sounds like she's had a thorough work up. Unfortunately a work up does not always reveal a cause (when a cause is found the most common diagnosis is multiple sclerosis). When no cause is found its called idiopathic optic neuritis.  That is not an uncommon problem.  Some of these fold eventually do develop signs of MS in future years.

JCH MD